HomeMy WebLinkAbout1506 W 11th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
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REQUEST
Date L) -I 4 - 67.-
374
Time
Received by
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I [tit + 1J Phone No
Permit No
(phone, person)
location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
(AJtlf-er
INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED
YES
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NO t/
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SURFACE RE TORA TION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # ? I / t
~OMPlETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
\" ater Distribution Repair Report
.b c..v - l.-ro I - 2.-11 (,
'Work Order No:
. ~/ I (.
, Crew
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1
DATE REPORTED
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REPAIR LOCA TI0N ADDRESS
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 6/
LEAKAGE SURVEY 0 OTIffiR 0
DATE OF REPAIR. ~ -It( - ci2 TIME.
I~ 6 .(
n (' '.1:.-.
cA C. - "'1_ SIZE.
1 i (
DEPTI! OF MAIN ~ CLOSEST VALVE DEPTII.
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TYPE OF MAIN
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK....JJ SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP V OTIffiR
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMP~SSERO OTIffiR
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
curs ASPHALT cur _FT CURB cur _FT SIDEWALK_FT
DRIVEWAY cur _FT
MAIN CONDITION INTERNAL LINING 11JBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE (;2 t P.P.M.
WATER OFF FROM r;..l- M. TO /0 Ii- M.
FROM M. TO
M.
APPARENT CAUSE OF LEAK.
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